Quantitative findings
The study identified a total of 35 (18 from Bahi and 17 from Kinondoni) district health-development partners (excluding national programmes) who were supporting the health sector in the two districts (see Fig. 1). NGOs (International, National and Regional) were the predominant health-development partners in the districts 30 (85%) out of 35 of all development partners. We found no difference in number of DPs between urban and rural District.
16 participants from 16 (46%) development partner organisations participated in a quantitative survey. The characteristics of the respondents are as shown in Table 1.
Table 1
Background Information of IP Respondents (N = 16)
Type of partner's organization
|
Total
|
Bahi
|
Kinondoni
|
International NGO
|
6
|
2
|
4
|
National NGO
|
6
|
3
|
3
|
Bilateral project
|
1
|
1
|
0
|
Multilateral project
|
1
|
0
|
1
|
FBO
|
2
|
2
|
0
|
Life span of the current project
|
≤ 5 years
|
5
|
2
|
3
|
> 5 years
|
11
|
6
|
5
|
Submission of activities to be included in CCHP
|
|
|
|
Yes
|
8
|
5
|
3
|
No
|
8
|
3
|
5
|
Six (38%) respondents (three from rural and three urban) reported to have received at least one document (guidelines, policies and other planning tools) from the district for them to use in developing their organization activity plans. CCHP template and guidelines were the commonest documents shared; none reported to have been using district health strategic plan and annual District CCHP in developing their plan. The IP respondents were asked to gauge their organization level of participation in the process of developing their respective district annual health plan (CCHP) as a general view and to specific CCHP development process. Majority of the respondents from Bahi (87.5%) had partial or substantial participation, while many participants from Kinondoni (62.5%) had not participated at all (zero participation). It was revealed that, out of 35 DPs present in the district, only 17 (48.6%) health DPs had submitted their activities to be included in the CCHP.
Table 2
DPs’ Participation to specific areas of CCHP Planning Process (N = 16)
Stage
|
Gauge
|
Total
|
Rural
|
Urban
|
Identifying priority health problems /intervention to be addressed in the 2014/15 CCHP Plan
|
Zero participation
|
5
|
1
|
4
|
Partial Participation
|
6
|
4
|
2
|
Full Participation
|
5
|
3
|
2
|
Allocating resources to the interventions
|
Zero participation
|
5
|
1
|
4
|
Partial Participation
|
7
|
5
|
2
|
Full Participation
|
4
|
2
|
2
|
Developing CCHP Action Plan
|
Zero participation
|
5
|
0
|
5
|
Partial Participation
|
6
|
5
|
1
|
Full Participation
|
5
|
3
|
2
|
Developing the capacity of the Council Health Planning Team
|
Zero participation
|
10
|
5
|
5
|
Partial Participation
|
4
|
3
|
1
|
Full Participation
|
2
|
0
|
2
|
Implementation of CCHP activities
|
Zero participation
|
5
|
0
|
5
|
Partial Participation
|
4
|
3
|
1
|
Full Participation
|
7
|
5
|
2
|
Evaluation and quarterly reporting
|
Zero participation
|
6
|
1
|
5
|
Partial Participation
|
5
|
3
|
2
|
Full Participation
|
5
|
4
|
1
|
17 (82.5%) DPs from Bahi district had submitted their plans but majority of DPs, 14 out of 18 (77.7%) from Kinondoni District had not submitted their plans to be included in the annual CCHP (see Table 2).
Review of the CCHP further showed that only 8% of DP activities submitted were included in the CCHP. We also found that 62.5% of the IP respondents from Bahi district perceived the district health planning team capacity to do the planning as excellent compared to 12.5% of Kinondoni district. It was revealed that majority of DPs from Kinondoni district (87.5%) perceived the process as average, low and poor.
DPs’ awareness on the Benefits of Engaging their activity plans into CCHP
Figure 2 show that DPs were aware of the benefits for partner organizations to participate and integrate their activities into the district CCHP. Some of the mentioned benefits were: organization visibility that is, recognition of the importance and presence of the organization by the district, getting priorities and areas of working and reducing running costs of an institution due to resources sharing.
Qualitative Findings
The study hypothesized that the implementation of the planning process below the national level might be challenged severely, the fact, which led to the ineffectiveness of the process engagement of DPs into CCHP. Therefore, to expand our understanding to those challenges, we did an in-depth interview (IDI) with 20 participants as shown in Table 3.
Table 3
Characteristics of the IDI Participants
Characteristic IDI Respondent
|
Total
|
Rural
|
Urban
|
Male
|
10
|
4
|
6
|
Female
|
10
|
5
|
5
|
Total
|
20
|
9
|
11
|
District official
|
8
|
4
|
4
|
DP Representative
|
10
|
4
|
6
|
RHMT
|
2
|
1
|
1
|
Total
|
20
|
9
|
11
|
Participants mentioned various challenges deterring the DPs from engaging in CCHP. These challenges were both from partners and the government. Below is the summary of the challenges that this study identified and their supporting quotes.
Differences in budget timeline;
“There is a problem of budget timeline. Whereas our financial year ends in June, the financial year of most of our partners start in October. This means that, by the time you engage them, they might say ‘we will see what to do’ but no commitment. Given these financial year differences, it becomes difficult to submit a paper of what they want to do because, and their donation would then not have been confirmed by their funder” (IDIDO1, Kinondoni).
Low predictability of funding from Prime donors
“One NGO which had never submitted its plan and we even have had not seen them in the field, came to our office asking us to rate them well as an independent assessor was coming for midterm review of the project”. (IDIDO3, Bahi).
Inadequate ffinancial allocation for pplanning activity
“There is a huge challenge on our side as we often don’t have the budget to enable our staff to attend, let’s say a five day CCHP planning which is usually done outside their district. So we end up by presenting our action plan to CHMT for them to consolidate. However, we do not get feedback from them whether they have included it or not” (” (IDIDP2, Bahi).
“When we invite development partners into the planning, we do not pay them, so those who can pay for themselves we normally accept them and we cooperate with them. Hence, we do not have cost implication except for meal and refreshments that we can accommodate”(IDIDO4, Kinondoni).
Few /irregular meetings
“I have been here for five years and have never been invited even to a single district coordination meeting” (IDIDP3, Bahi).
“We have in our council meeting schedule a quarterly NGO coordination meeting, but we often don’t hold these meetings as scheduled due to inadequate financing”(IDIDO2, Kinondoni).
Lack of transparency
“Most development partners are not transparent on their budget. They also never tell you their future commitments to the district. For example, that ‘we have this amount of money and we want to do this and that in this area of health” (IDIDO1, Bahi.)
Limited Knowledge and Skills among CHPT on Planning
“Developing a comprehensive council health plan is a technical activity requiring people who are knowledgeable and skilled in planning health-related activities. However, our staffs have not been well exposed to such type of trainings.” (IDIDO 3, Bahi).
Lack of Sufficient and Technically Qualified Human Resources among LGAs
“Potential employees, especially recently graduated young ones, do not like to work in the rural areas where there is poor working environment, particularly lack of staff houses, electricity, good office facilities and poor transport”(IDIDO1, Bahi).
Limitations of the Planning Tool (Plan rep)
“The planrep is not flexible to add our partners who do not appear in the planrep version. Therefore, we end up having difficulties entering their plans into planrep. Even in the quarterly reports, we do not report their activities.”(IDI DO 2, Bahi).